System for treating proximal humeral fractures and method of using the same

ABSTRACT

Various embodiments of the present invention provide systems and methods for treating a proximal humeral fracture. A system according to one embodiment includes a longitudinal member configured to be received within the humeral shaft. The system includes a jig assembly configured to be coupled to the longitudinal member, wherein the jig assembly includes at least one hole defined therethrough that is configured to guide placement of at least one hole in the humeral shaft, and wherein the hole formed in the humeral shaft is configured to align with at least one hole in the humeral implant such that the jig assembly is configured to locate the position of the humeral implant in the humeral shaft.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. application Ser. No.14/970,447, filed on Dec. 15, 2015, which is a divisional of U.S.application Ser. No. 13/910,694, filed Jun. 5, 2013, now U.S. Pat. No.9,241,723, which is a continuation of U.S. application Ser. No.12/707,238, filed Feb. 17, 2010, now U.S. Pat. No. 8,480,677, titled“System For Treating Proximal Humeral Fractures And Method Of Using TheSame,” which claims priority from U.S. Provisional Application No.61/154,064, filed Feb. 20, 2009, the contents of which are incorporatedherein by reference.

BACKGROUND OF THE INVENTION Field of the Invention

Various embodiments of the present invention relate to systems andmethods for treating proximal humeral fractures and, in particular, to asystem for locating and positioning an implant within the humeral shaftfor treating a proximal humeral fracture, wherein the system is capableof being used for standard and reverse shoulder arthroplasty andhemiarthroplasty.

Description of the Related Technology

Total shoulder replacement or arthroplasty may be indicated for thosewith severe arthritis, a fractured proximal humeral, or othercomplications. There are different types of arthroplasty procedures thatmay be performed depending on the patient. For example, total shoulderarthroplasty generally involves replacing the damaged bone and cartilagewith an implant. For a conventional shoulder arthroplasty, a metalimplant having a head is positioned within the humerus, and a polymericsocket is implanted within the scapula. A hemiarthroplasty involvesreplacing only one half of the shoulder joint, which may be suitable forpatients with proximal humeral fractures. Another technique forreplacing the shoulder is a reverse shoulder arthroplasty where thelocation of the head and socket are reversed, which may be indicated forpatients that have completely torn rotator cuffs.

Proximal humeral fractures treated with arthroplasty continue to bechallenging for the orthopedic surgeon. One of the difficulties is theamount of proximal humeral bone loss, which must be compensated for inselecting final component position. Previous systems have attempted toaddress these issues by incorporating a jig system to compensate forthese anatomical deficiencies. For example, U.S. Pat. No. 6,277,123 toMaroney et al. discloses one such jig system employing a clamp thatattaches to the humeral shaft. However, there are difficulties thatremain even with this jig in place both for hemiarthroplasty and reverseshoulder arthroplasty in the treatment of cases with proximal humeralbone loss. First, utilization of this jig requires a more extensivesurgical dissection to seat the jig. Second, the jig is by nature quitebulky and unwieldy in the surgical wound. Third, the alignment apparatusis not configured for utilization in reverse arthroplasty. Fourth, theamount of force required to reduce a reverse arthroplasty is muchgreater than in a hemiarthroplasty application. This amount of force maycause the jig to fail at either the implant interface or bone interface.

Thus, there remains a need in the art for an improved system fortreating proximal humeral fractures. In particular, there is a need forless complex and bulky system. In addition, there is a need for a systemthat is applicable to both hemiarthroplasty and reverse arthroplastythat builds off the existing shoulder platform.

SUMMARY

The above and other needs may be met by embodiments of the presentinvention which, in one embodiment, provides a system for treating aproximal humeral fracture. According to one embodiment, a system fortreating a proximal humeral fracture with a humeral implant having atleast one hole defined therethrough is provided. The system includes alongitudinal member configured to be at least partially received withinthe humeral shaft and a jig assembly configured to be coupled to thelongitudinal member. The jig assembly includes at least one hole definedtherethrough that is configured to guide placement of at least one holein the humeral shaft, wherein the at least one hole formed in thehumeral shaft is configured to align with the at least one hole in thehumeral implant such that the jig assembly is configured to locate theposition of the humeral implant in the humeral shaft.

According to one aspect, the system includes a longitudinal memberincluding at least one hole defined therethrough, wherein at least aportion of the longitudinal member including the at least one hole isconfigured to be received within the humeral shaft. In another aspect,the system includes a jig assembly configured to be coupled to thelongitudinal member, wherein the jig assembly includes at least one holedefined therethrough that is configured to align with the hole of thelongitudinal member and guide placement of at least one hole in thehumeral shaft, and wherein the at least one hole formed in the humeralshaft is configured to align with at least one hole in the humeralimplant such that the longitudinal member and the jig assembly areconfigured to locate the position of the humeral implant in the humeralshaft. According to various aspects of the system, the longitudinalmember and the jig assembly each includes a plurality of holes that areconfigured to align with one another. The at least one hole in thelongitudinal member and the at least one hole in the jig assembly may beconfigured to receive a drill bit therethrough and guide placement of abicortical or unicortical hole in the humeral shaft. The holes in thelongitudinal member and jig assembly may also be configured to guideplacement of a bicortical or unicortical pin in the humeral shaft. Inaddition, the longitudinal member may include a plurality of holesdefined therethrough at different radial and axial locations that areconfigured to determine a retroversion of the humeral implant.

The system may also include a fin clamp assembly including at least onehole defined therethrough that is configured to align with the at leastone hole in the humeral implant and the hole in the humeral shaft,wherein the fin clamp assembly includes a fin clamp configured to becoupled to a fin of the humeral implant. The fin clamp may include anextension member and a pin guide coupled thereto, wherein the pin guidecomprises the at least one hole configured to align with the at leastone hole in the humeral implant and the hole in the humeral shaft, andwherein the extension member is slidably engaged with the fin clamp foradjusting a relative distance between the pin guide and the fin clamp.Furthermore, the longitudinal member may include a coupling memberconfigured to abut the proximal end of the humeral shaft, wherein thejig assembly includes a coupling member configured to mate with thecoupling member of the longitudinal member. In another aspect, the jigassembly further comprises a guide slidably engaged with an armextending from the coupling member thereof for adjusting a relativedistance between the guide and the arm. The jig assembly may alsoinclude a pin guide comprising the at least one hole, wherein the pinguide is slidably engaged with the guide for adjusting a relative axialposition of the pin guide with respect to the guide.

An additional embodiment of the present invention is directed to amethod for treating a proximal humeral fracture with a humeral implanthaving at least one hole defined therethrough. The method includesinserting at least a portion of a longitudinal member within the humeralshaft and coupling a jig assembly including at least one hole definedtherethrough to the longitudinal member. The method further includesforming at least one hole in the humeral shaft guided by the hole of thejig assembly, wherein the at least one hole formed in the humeral shaftis configured to align with the at least one hole in the humeral implantsuch that the jig assembly is configured to locate the position of thehumeral implant in the humeral shaft.

In one aspect, the method includes inserting at least a portion of alongitudinal member including at least one hole defined therethroughwithin the humeral shaft and coupling a jig assembly including at leastone hole defined therethrough to the longitudinal member such that theleast one hole defined in the jig assembly aligns with the at least onehole of the longitudinal member. In another aspect, the method furtherincludes forming at least one hole in the humeral shaft guided by thealigned holes of the jig assembly and longitudinal member, wherein theat least one hole formed in the humeral shaft is configured to alignwith the at least one hole in the humeral implant such that thelongitudinal member and the jig assembly are configured to locate theposition of the humeral implant in the humeral shaft.

Additional aspects of the method include removing the longitudinalmember from the humeral shaft and inserting a trial humeral implanthaving at least one hole defined therethrough within the humeral shaft.The method may also include inserting a cortical (i.e., bicortical orunicortical) pin through the hole in the humeral shaft and the holedefined in the trial humeral implant. Furthermore, the method mayinclude aligning a first hole defined in a fin clamp assembly with thecortical pin and coupling the fin clamp assembly to the trial humeralimplant. The method may include inserting a unicortical pin in thehumeral shaft that is configured to align with a second hole defined inthe fin clamp assembly. The method may include removing the cortical pinfrom the trial humeral implant and removing the trial humeral implantfrom the humeral shaft. Moreover, the method may include inserting afinal humeral implant having at least one hole defined therethroughwithin the humeral shaft. The method may also include aligning the firstand second holes of the fin clamp assembly with the respective corticaland unicortical pins and coupling the fin clamp assembly to the finalhumeral implant.

According to another embodiment, a humeral implant for treating aproximal humeral fracture is provided. The humeral implant includes aproximal end and a distal end and a longitudinal axis extendingtherebetween, wherein at least the distal end is configured forinsertion within a humeral shaft. The humeral implant also includes aplurality of holes defined therethrough and transversely to thelongitudinal axis, wherein each of the holes is configured to align witha hole defined in the humeral shaft for locating the position of thehumeral implant in the humeral shaft. In accordance with one aspect, thehumeral implant is modular and includes a body and a stem that areinterchangeably coupled to one another, wherein the plurality of holesare formed through the stem.

An additional embodiment is directed to a kit for treating a proximalhumeral fracture. The kit includes a humeral implant comprising at leastone hole defined therethrough, a longitudinal member configured to be atleast partially received within the humeral shaft, and a jig assemblyconfigured to be coupled to the longitudinal member. The jig assemblyfurther includes at least one hole defined therethrough that isconfigured to guide placement of at least one hole in the humeral shaft,wherein the at least one hole formed in the humeral shaft is configuredto align with the at least one hole in the humeral implant such that thejig assembly is configured to locate the position of the humeral implantin the humeral shaft.

Aspects of the kit are directed to a longitudinal member including atleast one hole defined therethrough, wherein at least a portion of thelongitudinal member comprising the at least one hole is configured to bereceived within the humeral shaft. The kit may also include a jigassembly having at least one hole defined therethrough that isconfigured to align with the at least one hole of the longitudinalmember and guide placement of at least one hole in the humeral shaft. Inaddition, the hole formed in the humeral shaft is configured to alignwith the at least one hole in the humeral implant such that thelongitudinal member and the jig assembly are configured to locate theposition of the humeral implant in the humeral shaft. The kit mayoptionally include a fin clamp assembly that includes at least one holedefined therethrough that is configured to align with the at least onehole in the humeral implant and the at least one hole in the humeralshaft, wherein the fin clamp assembly is further configured to becoupled to the humeral implant. Moreover, the kit may include at leastone trial humeral implant and at least one final humeral implant.

An additional system embodiment includes a jig assembly comprising atleast one hole defined therethrough that is configured to guideplacement of at least one bicortical or unicortical hole in the humeralshaft. The hole formed in the humeral shaft is configured to align withthe at least one hole in the humeral implant such that the jig assemblyis configured to locate the position of the humeral implant in thehumeral shaft prior to implanting the humeral implant in the humeralshaft.

Moreover, a further system embodiment includes a fin clamp assemblycomprising at least one hole defined therethrough that is configured toalign with the at least one hole in the humeral implant and at least onehole previously formed in the humeral shaft. The fin clamp assembly isfurther configured to be coupled to the humeral implant to locate andsecure the humeral implant in the humeral shaft.

A further embodiment is directed to a system for treating a proximalhumeral fracture with a humeral implant having at least one hole definedtherethrough. The system includes a broach assembly configured to becoupled to the humeral implant and a jig assembly configured to becoupled to the broach assembly. The jig assembly includes at least onehole defined therethrough that is configured to align with the at leastone hole of the humeral implant and guide placement of at least one holein the humeral shaft for locating the position of the humeral implant inthe humeral shaft.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the invention will be better understood byreference to the Detailed Description of Various Embodiments of theInvention when taken together with the attached drawings, wherein:

FIG. 1 is a perspective view of a system for treating a proximal humeralfracture including a longitudinal member and a jig assembly according toone embodiment of the present invention;

FIG. 1A is a perspective view of a system for treating a proximalhumeral fracture including a longitudinal member and a jig assemblyaccording to one embodiment of the present invention;

FIG. 2 is a side view of a longitudinal member according to oneembodiment of the present invention;

FIG. 3 is an enlarged side view of the longitudinal member shown in FIG.2;

FIG. 4 is an enlarged perspective view of the jig assembly shown in FIG.1;

FIG. 5 is an enlarged side view of the jig assembly shown in FIG. 1;

FIG. 6 is a perspective view of the jig system shown in FIG. 1 includingan orientation pin and a drill bit positioned therethrough;

FIG. 7 is a perspective view of the jig assembly shown in FIG. 1including a drill bit positioned therethrough;

FIG. 8 is an enlarged perspective view of the jig assembly shown in FIG.1 including a drill bit positioned therethrough;

FIG. 9 is a perspective view of the system shown in FIG. 1 secured tothe humeral shaft and including a drill bit positioned therethrough;

FIGS. 10 and 11 are side views of trial humeral implants compatible withthe system shown in FIG. 1 according to embodiments of the presentinvention;

FIG. 12 is a side view of a final humeral implant positioned within thehumeral shaft and secured thereto with a pin according to one embodimentof the present invention;

FIG. 13 is a perspective view of a humeral final implant having a pinpositioned therethrough according to an embodiment of the presentinvention;

FIG. 14 illustrates different side views of final humeral implantshaving various sizes according to additional embodiments of the presentinvention;

FIGS. 15-17 are side views of a modular final humeral implant accordingto an additional embodiment of the present invention;

FIG. 17A is an end view of the stem shown in FIG. 17;

FIGS. 18 and 19 are side views of a modular trial humeral implantaccording to an additional embodiment of the present invention;

FIG. 20 is a perspective view of a broach assembly coupled to a jigassembly and a humeral implant that is positioned within the humeralshaft according to one embodiment of the present invention;

FIGS. 21 and 22 are perspective views of a broach assembly coupled to ajig assembly and a humeral implant that is positioned within the humeralshaft according to an embodiment of the present invention;

FIG. 23 is a photograph of a surgical procedure employing the broachassembly shown in FIGS. 21 and 22 and the jig assembly shown in FIG. 1for positioning a humeral implant within the humeral shaft.

FIG. 24 is a perspective view of a fin clamp assembly secured to ahumeral implant according to one embodiment of the present invention;

FIG. 25 is a side view of the fin clamp assembly and humeral implantshown in FIG. 24;

FIG. 26 is a front view of a fin clamp assembly coupled to a reverseshoulder humeral implant according to an embodiment of the presentinvention;

FIG. 27 is a perspective view of a humeral implant positioned within thehumeral shaft and the fin clamp assembly shown in FIG. 26 coupledthereto;

FIG. 28 is an enlarged perspective view of the reverse shoulder humeralimplant and fin clamp assembly shown in FIG. 26; and

FIGS. 29-37 are photographs of a surgical procedure employing a systemshown in FIG. 1 for treating a proximal humeral fracture.

DETAILED DESCRIPTION OF CERTAIN INVENTIVE EMBODIMENTS

Various embodiments of the present invention now will be described morefully hereinafter with reference to the accompanying drawings, in whichsome, but not all embodiments of the invention are shown. Indeed,various embodiments of the invention may be embodied in many differentforms and should not be construed as limited to the embodiments setforth herein; rather, these embodiments are provided so that thisdisclosure will satisfy applicable legal requirements. Like numbersrefer to like elements throughout. The singular forms “a,” “an,” and“the” include plural referents unless the context clearly dictatesotherwise.

As shown generally in FIGS. 1 and 4-9, embodiments of the presentinvention generally provide a system 10 that includes a longitudinalmember 12 and a jig assembly 14. Both the longitudinal member 12 and jigassembly 14 include respective holes 16, 18 that are configured to alignwith one another in order to locate the position of a humeral implant 22in the humeral shaft 26. As shown in FIGS. 24-28, the system 10 alsoincludes a fin clamp assembly 20 that is configured to be coupled to ahumeral implant 22. The fin clamp assembly 20 includes one or more holes24 that are also configured to locate and position the humeral implant22 within the humeral shaft 26. As explained in further detail below,the system 10 is capable of locating and positioning the humeral implantwithin the humeral shaft even where there is substantial proximalhumeral bone loss.

The system 10 is generally configured for positioning and placement of ahumeral implant 22 within a humeral shaft 26. In particular, the system10 may be used for standard and reverse shoulder arthroplasty orhemiarthroplasty procedures. The system 10 is also indicated forproximal humeral fractures where there is proximal humeral bone loss,such as where all or a portion of the humeral head has been fractured.Although the embodiments are discussed in conjunction for treatment ofproximal humeral fractures, it is understood that the system may beadapted for other long bones in accordance with additional embodimentsof the present invention. For example, the system 10 may be modified foruse with long bones such as the tibia or femur where an end of the bonehas been fractured.

Referring to FIGS. 2 and 3, there is shown a longitudinal member 12according to one embodiment of the present invention. The longitudinalmember 12 has a T-handle 28 at its proximal end 30 that is capable ofbeing gripped by a physician for handling and positioning thelongitudinal member in the humeral shaft 26. The distal end 32 of thelongitudinal member 12 is configured for placement within the medullarycanal of the humeral shaft 26. The longitudinal member 12 also includesa plurality of holes 34 that are offset radially and axially along thelongitudinal member from one another. The holes 34 are configured toreceive an orientation pin 36 that is used to determine the version ofthe humeral implant (see FIG. 6). For example, the version may bedetermined by positioning an orientation pin 36 through one of the holes34 and comparing the orientation of the pin to the orientation of thepatients forearm. The longitudinal member 12 may be rotated internallyor externally to achieve a desired version. There may be any number ofholes 34 that are offset at various angles from one another, such as 10°from one another within a range of about 0 to 40° of version.

In addition, the longitudinal member 12 includes a coupling member 38that is configured to mate with a coupling member 40 of the jig assembly14, wherein the coupling members may be secured together with a fastener42, as shown in FIG. 4. In particular, the coupling member 38 includes ashoulder 41 and a raised portion 43, while the coupling member 40includes a pair of clamp members 45 separated by a channel 47. The clampmembers 45 are capable of being positioned around the longitudinalmember 12 by positioning the longitudinal member within the channel. Theclamp members 45 may abut the shoulder 43 and be secured to thelongitudinal member 12 and the raised portion 43 with the fastener 42.

The longitudinal member 12 also includes a plurality of holes 16 locateddistally of the coupling member 38 that are configured to be disposedwithin the humeral shaft. The holes 16 are spaced axially apart from oneanother, such as about 3-5 mm from one another. The holes 16 are sizedand configured to guide the formation of a cortical hole within thehumeral shaft, such as by receiving and guiding a drill bit 39therethrough (see FIGS. 6-8). Although five or six holes 16 are shown inFIGS. 1 and 2, there may be one or more holes depending on the amount ofheight adjustment desired in order to position the humeral implant 22within the humeral shaft 26. Alternatively, FIG. 1A illustrates that thelongitudinal member 12 may not have holes 16 defined therein, which maybe used for placement of one or more unicortical holes in the humeralshaft 26 as described below.

The jig assembly 14 generally includes guide 44 coupled to an arm 46extending from the coupling member 40. The arm 46 includes a groove 50that is configured to mate with a corresponding ridge (not shown) withinthe guide 44. Thus, the guide 44 may slide along the arm 46 to adjustthe distance between the guide and the coupling member 40. The jigassembly 14 also includes a pin guide 52 and an extension member 54. Theextension member 54 is configured to be received within an opening (notshown) defined in the guide 44 such that the extension member isconfigured to move axially through the opening. Thus, the extensionmember 54 may be used to adjust the position of the pin guide 52 withrespect to the guide 44. The guide 44 and extension member 54 may besecured together with a fastener 48 such that the position of the pinguide 52 may be fixed when the fastener is tightened. Although theposition of the jig assembly 14 is disclosed as being adjustable, it isunderstood that the position of the guide 44 and/or pin guide 52 may beadjusted or even fixed in position such as by welding.

As stated above, the jig assembly 14 includes a plurality of holes 18for facilitating the positioning of the humeral implant 22 in thehumeral shaft 26. In particular, the pin guide 52 includes a pluralityof holes 18 defined therethrough that are configured to align with theplurality of holes 16 defined in the longitudinal member 12. Thus, theholes 18 are also configured to guide the formation of a hole within thehumeral shaft, such as by receiving and guiding a drill bit 39therethrough (see FIGS. 6-8). The drill bit 39 is configured to beinserted within a hole 18 in the jig assembly 14 and a correspondinghole 16 in the longitudinal member 12, which may be useful for guiding aunicortical or bicortical hole into the humeral shaft 26. In thealternative, the longitudinal member 12 may not have holes 16 as shownin FIG. 1A such that the drill bit 39 is guided only by one of the holes18 in the jig assembly 14, which may be used to guide a unicortical holeinto the humeral shaft 26. As before, although five holes 18 are shownin FIG. 1, there may be one or more holes depending on the amount ofheight adjustment desired in order to position the humeral implantwithin the humeral shaft.

Moreover, the jig assembly 14 is able to transfer the version determinedusing the longitudinal member 12 and orientation pin 34 to the humeralimplant 22 when one or more holes are drilled in the humeral shaft 26while being guided by one or more corresponding holes 18. In particular,once the desired version is obtained using the orientation pin 36, thehole formed in the humeral shaft 26 via the jig assembly may memorizethe version and allow the physician to insert a pin 78 in the humeralimplant 22 and humeral shaft at the same version.

As indicated above, the system 10 is capable of being used to position ahumeral implant 22 within the humeral shaft. FIGS. 10-14 show varioushumeral implants 22 according to embodiments of the present invention.The humeral implant 22 may include conventional features, such as a stem58, a body 60, anterior, posterior, and/or lateral fins 62, and heightindicators 74 (e.g., laser lines formed on the body). The fins 62 mayinclude one or more holes 70 for receiving a suture. The humeral implant22 may also include a collar 64 that may be configured to be coupledwith a head 66 for a conventional shoulder arthroplasty (see FIG. 27),or may be configured as a socket for a reverse arthroplasty (see FIG.28). Moreover, the humeral implant 22 may include a plurality of holes56 defined therethrough. The holes 56 are configured to align with theholes 16, 18 defined in the longitudinal member 12 and jig assembly 14,respectively. As explained in further detail below, each of the holes 56is sized and configured to receive a pin 78 in order to position thehumeral implant 22 within the humeral shaft (see FIGS. 12 and 13). Theholes 56 may be defined in both a trial humeral implant that is used todetermine the position of the final humeral implant, as well as thefinal humeral implant, which is also explained in further detail below.It is understood that the humeral implant 22 may be various sizes andconfigurations for accommodating patients having varying sizes andinjuries. For instance, the stem 58 length may range between about 100and 250 mm, the stem diameter may range between about 4 to 20 mm, andthe head 66 may have a radius of about 40 to 60 mm and a height of about10 to 30 mm. The humeral implant 22 is typically a metal material (e.g.,titanium or cobalt chromium), and the body 60 may optionally include aporous coating for facilitating fixation with bone. According to oneembodiment, the humeral implant 22 may be similar to that disclosed byU.S. Pat. No. 6,283,999 to Rockwood, Jr., which is incorporated hereinby reference, wherein the humeral implant may be modified for use withthe system 10 by forming holes 56 in the stem 58.

FIGS. 15-19 illustrate another embodiment of a humeral implant 80.Namely, the humeral implant 80 is modular and includes a stem 82, a body84, and a head 86 that are sized and configured to be interchangeablycoupled to one another. FIGS. 18 and 19 depict a trial humeral implant80, and FIGS. 15-17 depict a final humeral implant. Each humeral implant80 includes a stem 82 having a tapered opening 88 that is configured toreceive a mating tapered end 90 of the body 84. The body 84 alsoincludes a tapered opening 92 that is configured to receive a taperedpost 94 of the head 86. The tapered end 90, post 94, and openings 88, 92may be coupled, for example, with a standard or reverse Morse taper.FIGS. 16, 18, and 19 demonstrate that the body 84 may include a reverseMorse taper, while the tapered ends 90 and opening 88 may include aMorse taper. The humeral implant 80 may also include visible indicators(e.g., laser lines) for indicating the height 74 and rotational 96location of the stem 82 within the humeral shaft.

Thus, the stem 82, body 84, and head 86 are engageable with one anotherand may be interchangeable. The tapered ends allow the stem 82, body 84,and head 86 to interlock with one another in a press fit. As such, aphysician is able to implant the humeral implant 80 as a singleinterlocking piece or in a step-wise fashion. Moreover, because the stem82, body 84, and head 86 are not permanently attached to one another,one or more of the components may be exchanged during or afterimplantation.

The humeral implant 80 may be various materials, such as a metal and/orpolymer. For instance, the trial humeral implant 80 may include a metalstem 82 and a polymer body 84. In addition, the humeral implant 80 maybe various sizes and configurations for accommodating different patientsand injuries. For example, the body 84 may include three differentstem/body sizes (e.g., 6/8 mm, 10/12 mm, or 14/16 mm stems and have alength that is small, medium, or long. Thus, the modular design mayreduce the number of sizes of humeral implants needed given theflexibility in adjusting the position of the stem 82, body 84, and head86. In addition, the humeral implant 80 may be sized and configured tobe compatible with conventional heads 86.

According to another embodiment, a broach assembly 150 may be employedto guide one or more holes in the humeral shaft 26 for positioning atrial humeral implant 22 therein, as shown in FIGS. 20-23. The broachassembly 150 may be modified to include one or more holes 34 fordetermining the version of the humeral implant 22, as described above(see FIG. 20). In addition, the broach assembly 150 is configured to becoupled to the trial humeral implant 22 with a fastener 152 or othertechnique known to those of ordinary skill in the art. The jig assembly14 may also be coupled to the broach assembly 150 with a fastener 42 inorder to guide placement of a hole in one or more of the holes 56 in thetrial humeral implant 22. For instance, a bicortical or unicortical holemay be formed directly through a hole 56 in the trial humeral implant 22with a drill bit 39 that is guided by a hole 18 in the jig assembly 14(see FIGS. 21 and 22). After a bicortical or unicortical hole has beenformed in the humeral shaft 26, a cortical pin 78 may be inserteddirectly through the hole 56 in the trial humeral implant 22 and thehole formed in the humeral shaft, and a unicortical pin may be insertedin the humeral shaft. Thus, the broach assembly 150 may provide astep-saving technique whereby use of the longitudinal member 12 isunnecessary.

FIGS. 24-28 illustrate a fin clamp assembly 20 according to oneembodiment of the present invention. The fin clamp assembly 20 isemployed to position the humeral implant 22 within the humeral shaft 26,as shown in FIGS. 24 and 25. The fin clamp assembly 20 includes a finclamp 98 that is configured to be coupled to the humeral implant 22. Inparticular, the fin clamp 98 includes a first fastener 100 that isconfigured to secure the fin clamp to one of the fins 62 of the humeralimplant 22. For instance, FIGS. 24 and 25 depict the fin clamp 98secured to the anterior fin 62. The fin clamp 98 may be configured toengage one of the holes 70 or an indentation in the fin. The fin clampassembly 20 also includes an extension member 102 and a pin guide 104.The fin clamp 98 includes an opening (not shown) that allows the pinguide 104 to be moved therethrough for adjusting the position thereofwith respect to the fin clamp. A second fastener 106 may be employed tosecure the fin clamp 98 to the extension member 102, thereby fixing theheight of the pin guide 104. A third fastener 108 is shown and may alsobe used to secure the fin clamp 98 to the humeral implant 22, althoughtypically only fasteners 100, 106 are necessary. A fin clamp 98according to one embodiment of the present invention that may beemployed with the fin clamp assembly 20 is disclosed by U.S. Pat. No.6,277,123 to Maroney et al., which is incorporated herein by reference.

Furthermore, the fin clamp assembly 20 includes a plurality of holes 24defined therethrough, wherein at least one of the holes is configured toalign with a respective hole 56 in the humeral implant 22 and a holeformed in the humeral shaft 26. The holes 24 are each sized andconfigured to receive a pin 78 therethrough for locating the position ofthe humeral implant 22 and positioning the implant within the humeralshaft 26. For example, the holes 24 may be sized to receive a pin 78having a diameter of about 3.2 mm. In one embodiment, the holes 24 aresized and configured such that the fin clamp assembly 20 is capable ofbeing slid over the pins 78 while the pins are engaged in the humeralshaft 26. The pin guide 104 is shown as having two or five holes definedtherein, however, it is understood that the pin guide may have one ormore holes.

In use according to one embodiment of the present invention, thelongitudinal member 12 is positioned within the reamed medullary canalof the humeral shaft 26 such that the coupling member 38 is positionedproximate to, or abuts, the proximal end of the fractured end of thehumeral shaft 26. The jig assembly 14 is then coupled to thelongitudinal member 12 with the fastener 42, and the position of the jigassembly is fixed with respect to the longitudinal member with fastener48. Typically, the longitudinal member 12 and jig assembly 14 arecoupled prior to inserting the longitudinal member within the humeralshaft 26, although the longitudinal member could be positioned withinthe humeral shaft before attaching the jig assembly thereto. In order todetermine the version of the humeral implant 22, an orientation pin 36may be inserted through one of the holes 34 defined in the longitudinalmember 12. According to one embodiment, the orientation pin 36 isinserted within a hole 34 located between 0 and 40 degrees of versionsuch that the pin aligns with the longitudinal axis of the patient'sforearm (see FIG. 29). Once the physician is satisfied with the versionand the position of the longitudinal member 12 and jig assembly 14, thephysician will get an idea of the size of the humeral implant 22 thatwill be necessary. Depending on the size of the humeral implant 22needed, the physician will insert a drill bit 39 through one of theholes 18 in the jig assembly 14 and into a corresponding aligned hole 16in the longitudinal member 12 and form a first hole 110 in the humeralshaft 26 (see FIGS. 9 and 30). The physician may then drill a secondhole 112 in the humeral shaft 26 with the drill bit 39 that is guidedthrough a second hole 18. The first hole 110 may be a bicortical orunicortical hole formed in the humeral shaft 26, while the second hole112 may be a unicortical hole formed inferior to the first bicortical orunicortical hole 110 (see FIG. 25). The second unicortical hole 112 maybe placed through one of the openings 18, 24 in the jig assembly 14 orfin clamp assembly 20, respectively. Alternatively, a threadedunicortical pin can be utilized in place of drilling the second hole112. Another alternative would be to eliminate the use of theunicortical hole 112 and associated pin and, instead, utilize the firsthole 110 as the only fixation point.

Once the holes have been formed in the humeral shaft 26, thelongitudinal member 12, jig assembly 14, and orientation pin 26 may beremoved from the humeral shaft. A trial humeral implant 22 may then beinserted within the medullary canal of the humeral shaft 26 (see FIG.31). At this time the physician may then adjust the height of the trialimplant 22 by choosing the appropriate hole 56 in the trial humeralimplant 22. The physician then inserts a pin 78 through the first hole110 and into the humeral shaft 26 and through one of the holes 56defined in the trial humeral implant 22 (see FIGS. 24, 25, 27, 28, 32,and 33). The physician may then also insert a second pin 78 into thesecond hole 112, but the hole is unicortical such that the pin does notengage the trial humeral implant (see FIGS. 25 and 35-37). Next, thephysician may slide the fin clamp assembly 20 over the pins 78, adjustthe height of the pin guide 104 if necessary using the extension member102 and fastener 106, and secure the fin clamp 98 to the anterior fin 62of the trial humeral implant 22 using the fastener 100 (see FIGS.34-37). The physician can note the height of the trial humeral implant22 based on experience and/or the height indicators 74.

Once the position of the fin clamp assembly 20 and humeral implant 22have been determined, the fin clamp may be removed from the trialhumeral implant 22. The cortical pin 78 is retracted from the trialhumeral implant 22, and the trial humeral implant is removed from thehumeral shaft 26. Bone cement is mixed and provided in the medullarycanal in preparation for receiving the final humeral implant 22. Thefinal humeral implant 22 is inserted in the medullary canal, and the finclamp assembly 20 is again slid over the pins 78. The fin clamp 98 isthen secured to the anterior fin 62 in the same position that was notedwhen determining the location of the trial humeral implant 22. The finclamp assembly 20 is left in position until the bone cement cures, andthen the fin clamp assembly and pins 78 are removed. The drill holes110, 112 for the pins 78 are proximal in the remaining humeral shaft 26and can be filled with a small amount of bone graft to prevent anycement extrusion, if desired. Or, the physician may insert a fastener(not shown) through one or both of the holes 110, 112 to further fixatethe humeral implant 22 within the humeral shaft 26.

Therefore, embodiments of the present invention may provide severaladvantages. For example, the system 10 may provide techniques foraccurately locating a humeral implant 22 within a fractured humeralshaft 26 for both shoulder hemiarthroplasty and reverse arthroplasty.The system 10 may also accurately determine both version and height forthe humeral implant 22. For reverse arthroplasty, the system is robustby utilizing cortical fixation of the pin 78 through the trial humeralimplant 22. This fixation may accommodate the forces necessary to assesstensioning and joint stability. The system 10 is less bulky thanconventional systems and offers a simpler technique to slave the finaltrial position to the final implant position. Furthermore, forhemiarthroplasty, surgical dissection is minimized, and the ease ofchanging height intraoperatively is greatly enhanced. In both reversearthroplasty and hemiarthroplasty, the system 10 may be built aroundcurrent surgical instrumentation, which reduces the need tosignificantly redesign current surgical instruments and techniques.

Many modifications and other various embodiments of the invention setforth herein will come to mind to one skilled in the art to which thisinvention pertains having the benefit of the teachings presented in theforegoing descriptions and the associated drawings. Therefore, it is tobe understood that the various embodiments of the invention are not tobe limited to the specific embodiments disclosed and that modificationsand other embodiments are intended to be included within the scope ofthe appended claims. Although specific terms are employed herein, theyare used in a generic and descriptive sense only and not for purposes oflimitation.

What is claimed is:
 1. A method of positioning a humeral implant withina humeral shaft, comprising: providing a humeral implant having at leastone hole defined therethrough; positioning a longitudinal rod member forreceipt within a reamed medullary canal of the humeral shaft; coupling ajig assembly having a plurality of holes to said longitudinal rod memberwith a fastener to fix the position of the jig assembly with respect tothe longitudinal rod member; and inserting the longitudinal rod memberwithin the humeral shaft; inserting a drill bit through one of saidplurality of holes in said jig assembly and into a corresponding alignedhole in the longitudinal rod member to form a first hole in the humeralshaft; after forming the first hole in the humeral shaft, removing thelongitudinal rod from the humeral shaft and inserting a portion of thehumeral implant including the at least one hole therethrough into thereamer medullary canal of the humeral shaft; and coupling the jigassembly to the humeral implant with the fastener to align the at leastone hole defined through the humeral implant with the first hole drilledin the humeral shaft such that the jig assembly assists in locating theposition of the humeral implant in the humeral shaft.
 2. The method ofclaim 1, further comprising inserting an orientation pin within saidhole of said humeral implant.
 3. The method of claim 2, wherein said pinaligns with the longitudinal axis of a patient's forearm.
 4. The methodof claim 1, further comprising drilling a second hole in the humeralshaft with a drill bit, wherein said drill bit is guided through asecond hole in said jig assembly.
 5. The method of claim 1, wherein saidfirst hole is a unicortical hole or a bicortical hole.
 6. The method ofclaim 4, wherein said second hole is a unicortical hole formed inferiorto said first hole.
 7. The method of claim 1, further comprisingremoving said longitudinal rod member, jig assembly and orientation pinfrom the humeral shaft.